The Care Act:Reforming Care & Support

Healthwatch Consultation Event21 January 2015

• Janet Cole Head of Early Intervention, Prevention & Rehabilitation• Jeremy DeSouza, Assistant Director Finance and Resources

What is the Care Act?“reforms mark a generational shift in our system of care, a shift from a system that is essentially paternal, reactive and prescribed to one that is preventative, personalised and proactive in its care approach.

A system that focuses on people's strengths, that seeks to secure personal wellbeing replacing one that focuses on deficits and meeting need.” Jon Rouse Director General for Social Care, Dept. of Health, May 2014

What is the Care Act?

• Biggest change in Adult Social Care legislation for over 60 years:

• Based on principle of wellbeing

• Encompasses whole population

• The Act is a platform for the next few decades albeit in tough times

Summary of Care Act DutiesKey requirements Timing

Duties on prevention and wellbeing From April 2015Duties on information & advice (inc paying for care)

Duty on market shaping

Assessments (including carers’ assessments)

National minimum threshold for eligibility

Personal budgets and care and support plans

Safeguarding

Universal deferred payment agreements

Extended means test From April 2016Care accounts

Capped charging system

Care Act - Timeframes

Phase One: Draft Guidance/Regulations published May 2014 and consulted on

throughout summer Final Guidance/Regulations issued end October 2014 Implementation commences April 2014

Phase Two Draft Guidelines to be issued January 2015 for 12 week

consultation Final guidance/regulations October 2015. Autumn 2015 existing service users assessed for Care Accounts April 2015 full implementation

Prevention Strategy

Janet ColeHead of Early Intervention, Prevention and Reablement

Introduction

What the Care Act says about prevention Current preventative services Scope of the strategy Approach to developing the local strategy Approach to engagement What the strategy is aiming to achieve

Care Act - Three levels of prevention

Current services in Public Health & Social Care

Public Health Primary Prevention services: Livewell, Stop Smoking, NHS Health

Checks, Winter warming

Social Care Wide range of services across all levels of prevention e.g.

Rehabilitation, Falls, Equipment, Information and Advice, Home Maintenance. Many joint funded with CCG

Wide and comprehensive offer compares favourably to other councils. However services developed incrementally over time; some in place for

a long period. Must now assess whether these services meet the needs of the resident population

Scope of the Prevention Strategy Borough wide strategy with health, social care, other council

departments and community representatives Preventative services to meet resident’s identified needs

within existing resources. Includes information & advice services Partnership approach and a wider offer - not just health and

social care Prevention services targeted for different groups Impact and outcomes long term

Approach to developing the strategy Multi agency steering group Needs analysis and service

mapping Identify best practices &

innovation Identify gaps Consultation Recommendations on

services that need re-shaping or commissioning

Strategy completed spring 2015

Engagement Two workstreams have been developed to cover residents’ varying

adult social care needs

What the Strategy is aiming to achieve

Shift in approach for: • 1) the public (doing more for themselves); • 2) professionals (making every contact count).

Key cultural change Resource Directory Council & CCG reshaping re-commissioning current

services to meet need – wider determinants of health, education, housing, employment, environment, etc.

New technologies to replace or complement existing services

Promote & provide tools for self care

Questions about Prevention

Social Care Charging

Jeremy DeSouza

Assistant Director – Finance and Resources

Changes to Social Care ChargesKey requirements Timing

Duties on information & advice re paying for care From April2015New charging framework in line with national eligibility

for service users/carers

Universal deferred payment agreements

Entitlement for self-funders to ask Council to arrange their care

Extended means test – more people to access state funded support (capital limit increased to £118,000 from £23,250 for care homes)

From April 2016

Lifetime cap on care costs introduced (£72,000)

Care Accounts – to track progress towards the cap on care costs

Universal Deferred Payments Prevents people from having to sell their home in their

lifetime to fund their care (in a care home) Allows payments to be made after the service user’s

death when the property is sold Must be made available to all home owners receiving

care in a care home Interest charges will apply Costs of setting up/monitoring the agreement to be

recovered from service users

Universal Deferred Payments Administration fee of £2,500 paid upfront or added to the

loan Interest rate - max rate set by DH (currently 2.65%) –

updated twice yearly Interest charges compound basis - added every six

months Debt secured by first charge on the property Equity Limit is 90% of property value less £14,250 (e.g.

Property worth £500,000 Equity Limit is £450,000 – 14,250 = £435,750

Criteria for Deferred Payment

Someone with eligible care needs requiring care in a care home

Someone with less than £23,250 in savings/ other non-property assets

Someone whose property is taken into account in their financial assessment i.e. home not occupied by spouse or dependent relative

Case Study

Joan needs residential care @£670pw and has savings of £15,000 and house worth £300,000

Joan has to pay for her care as assets above £23,250, but only has £15,000 easily accessible in savings

Joan enters into a Deferred Payment agreement with the Council and agrees to charge on her property

The Council pays the care home fees £670 pw Joan makes a contribution of £86 pw from her income

and defers £584 pw

Case Study continued After 1 year Joan sells her house with her family’s help Joan repays the Council £33,311 which includes interest

of £443, admin fee of £2,500 and care home fees of £30,368

The overall cost to Joan is £2,463 more than the current scheme (due to the admin fee and interest)

Joan chose to retain the maximum disposable income allowance of £144 pw from her income – she may have chosen to retain less disposable income and reduce the amount deferred.

Joan could have rented out her property, providing additional funding towards her care home fees.

Implementation Issues

Ensuring quality information and advice Ensuring the scheme is accessible Encouraging homes to remain in use Facilitating support to families with property

rental arrangements Protecting the public purse/ensuring recovery of

deferred payment loans

Self Funders Can now request Council to arrange their care at home

(criteria - eligible care needs & savings above £35,000) Does not apply to care in a care home (expected to be

introduced in 2016) Does not apply where someone cannot make own

arrangements; Council must arrange care and not charge

Charges can be made to cover costs (i.e. brokerage administration, contract monitoring, quality assurance, invoicing and debt recovery)

Proposal that charges will fully recover costs of making arrangements, so this change will be cost neutral to the Council

Implementation Issues

Ensuring the Council’s resources are targeted at those with the most need

Encouraging self-funders to make their own arrangements where it is practical to do so

Supporting local providers who may wish to provide this service

Providing information about local care provision so that self-funders have the right information to arrange their own care

Case StudyAnne is aged 80 and needs some support to live at home and is able to make her own care arrangements through a local care provider and also has a son living nearby who is willing to help with this. Her savings are £70,000.

Anne asks the Council to arrange her care. The weekly cost of her care is £260 and the fee for arranging her care is £50pw.

Alternatively Anne can receive information and advice from the Council and voluntary organisations about her care and either make her own arrangements or through an organisation such as RUILS, which would charge a fee.

Consultation This event forms part of our consultation process on

proposals for April 2015 regarding services for self-funders

Consultation will be open to residents and local organisations via the Council’s website

Purpose of today to seek views and develop practical solutions to address any implementation issues identified

Questions about Social Care Charges